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Nursing Fundamentals Focus VIII        Oxygenation
Objectives•  List and discuss the major body structures.• Discuss functions responsible for proper oxygenation• Describe f...
Staggering statistics• Pulmonary Diseases • Lung CA - • TB – • Pneumonia – • Chronic Airflow Limitation (formerly COPD) –
Staggering statistics• Cardiovascular Diseases – # 1 killer • HTN – 65 million • Artheriosclerosis • Arteriosclerosis • St...
Respiratory System
Process of Breathing•Inspiration • Air flows into lungs•Expiration • Air flows out of lungs
Normal Oxygenation Process• Cardiovascular:
Normal Oxygenation Process• Systemic:
Normal Oxygenation Process
Inspiration• Diaphragm and intercostal muscles contract• Thoracic cavity size increases• Volume of lungs increases• Intrap...
Expiration• Diaphragm and intercostal muscles relax• Lung volume decreases• Intrapulmonary pressure rises• Air is expelled
Gas Exchange• Occurs after the alveoli are ventilated• Pressure differences (gradient) on each side of the  respiratory me...
Adequate O2 Balance• Maintenance of adequate O2 balance Gas Exchange
Oxygen Transport• Transported from the lungs to the tissues• 97% of O2 combines with RBC Hgb   oxyhemoglobin carried to t...
Normal Oxygenation Process• Cell environment / O2 carrying capacity:• O2 Carrying capacity of blood is expressed by: • Red...
Carbon Dioxide Transport• Must be transported from tissues  lungs• Continually produced in the process of cell  metabolis...
Factors that Influence         Respiratory Function• Age• Environment• Lifestyle• Health status• Medications• Stress
Common Manifestations of Impaired        Respiratory Function•Hypoxia•Altered breathing patterns•Obstructed or partially o...
Hypoxia• Condition of insufficient oxygen anywhere in the body• Rapid pulse• Rapid, shallow respirations and dyspnea• Incr...
Abnormal Respiratory Patterns• Tachypnea (rapid rate)• Bradypnea (abnormally slow rate)• Apnea (cessation of breathing)• K...
Alterations in Ease of Breathing• Orthopnea• Dyspnea
Obstructed or Partially         Obstructed Airway• Partial obstruction • low-pitched snoring during inhalation• Complete o...
Adequate O2 Balance    Example of Obstructive Disease: Asthma•
Adequate O2 Balance    Example of Restrictive Disease: Hemothorax•
Inadequate O2 Balance•   Behaviors of Negative O2 balance    • Hypoventilation or hyperventilation    • Stridor, audible s...
Nursing Responsibilities• Determine adequacy of cardiopulmonary function:    • Nursing assessment      • HEART      • Resp...
HEART• Have client describe  • specific location, onset and duration of the problem• Explore associated signs and symptoms...
Heart ProblemsArtheroscleosis = Coronary Artery Disease (CAD)
Nursing Measures to Promote Respiratory                Function• Ensure a patent airway• Positioning• Encourage deep breat...
Nursing Responsibilities• Physical Assessment:    • Lung auscultation and breathing pattern    • Abdominal assessment    •...
Lung sounds• Diminished or absent• Crackles course and fine  • discontinuous course bubbling  • fine crackling sound at th...
Common Tests and Nursing Responsibilities•Measure adequacy of ventilation and gas exchange    • Complete Blood Count (CBC)...
Common Tests and Nursing Responsibilities•Tests to determine abnormal cell growth or infectionin respiratory system:    • ...
Common Tests and Nursing Responsibilities• Tests to visualize structures of  respiratory system:    • Bronchoscopy    • Ch...
Chest XrayAdenocarcinoma
Common Tests and Nursing Responsibilities                         Thorancentesis
Nursing Responsibilities• Medications• Incentive spirometry• Chest PT• Postural drainage• Oxygen therapy• Artificial airwa...
Basic Nursing Interventions• Airway Maintenance: • Facilitate effective coughing • Suctioning airways • Liquefying and mob...
Basic Nursing Interventions• Maintenance and promotion of proper lung  expansion:Re-expanding collapsed lungs- Closed Ches...
Chest Tubes
Basic Nursing Interventions• Improving Activity Tolerance: • Determine etiology • Assess appropriateness of activity level...
Basic Nursing Interventions• Mobilization of Pulmonary Secretions • Auscultate breath sounds, monitor respiratory   patter...
Incentive spirometry
Basic Nursing Interventions• Mobilization of Pulmonary Secretions • Encourage activity and ambulation as tolerated • Encou...
Basic Nursing Interventions• O2 Therapy:  • Low flow  • High flow  • Humidification  • Nasal cannula  • Simple mask  • Non...
Basic Nursing Interventions    • Effective Breathing Techniques• Position for maximal respiratory function• Pursed lip bre...
Basic Nursing InterventionsStress and anxiety reduction:• Remove pertinent cause of anxiety at that moment  - help client ...
Administration of Prescribed         Medications• Expectorants         • Vasoconstrictors• Mucolytics• Bronchodilators• Co...
Basic Nursing Interventions• Physical Exercise health teaching Activity and rest --      a priority ! Activity stimulates...
Adequate O2 Balance• Behaviors of Negative O2 balance  Cardio Vascular Disease• Arterial• Venous:• Impaired tissue perfus...
Adequate O2 Balance• Behaviors of Negative O2 balance  CV• Restlessness, dizziness, syncope, bradycardia,  decreased urin...
Common Tests and Nursing ResponsibilitiesTests to determine adequacy of cardiovascular   •function:    • CBC    • Lipid pr...
Basic Nursing InterventionsCardiovascular                  •Diet• Modify risk factors           •Exercise                 ...
Basic Nursing Interventions• Cardiovascular            •Risk DVT                            •Position changes     -   Prev...
Basic Nursing Interventions                           -   Position semi to highCardiovascular                 fowlers-> de...
Basic Nursing InterventionsCardiovascular        •Avoid appetite suppressants, cold• Avoid stimulants    meds, coffee, tea...
Basic Nursing Interventions                       • Administer O2Cardiovascular                       • Educate client• In...
Administration of Prescribed               Medications• Anti coagulants• Vasodilator  Medications• Inotropic Medications• ...
Basic Nursing Interventions• Dietary control • Assess nutritional status • Consider a dietician referral to assess   nutri...
Basic Nursing Interventions• Weight control• Evaluate the client’s physiological status in relation  to condition  • More ...
nursing - oxygenation
nursing - oxygenation
nursing - oxygenation
nursing - oxygenation
nursing - oxygenation
nursing - oxygenation
nursing - oxygenation
nursing - oxygenation
nursing - oxygenation
nursing - oxygenation
nursing - oxygenation
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nursing - oxygenation

  1. 1. Nursing Fundamentals Focus VIII Oxygenation
  2. 2. Objectives• List and discuss the major body structures.• Discuss functions responsible for proper oxygenation• Describe factors that may alter ones O2 balance.• Identify the behaviors indicating negative O2 balance.• Review the common diagnostic tests medically prescribed in order to determine the client’s oxygenation status.• Explain the major purpose of the tests and the related nursing responsibilities.
  3. 3. Staggering statistics• Pulmonary Diseases • Lung CA - • TB – • Pneumonia – • Chronic Airflow Limitation (formerly COPD) –
  4. 4. Staggering statistics• Cardiovascular Diseases – # 1 killer • HTN – 65 million • Artheriosclerosis • Arteriosclerosis • Stroke • Hypercholesterolemia • 107 million - a risk factor for CVD • AMI – 7.5 Million per year, 460,000 die • Americans paid 393.5 billion in 2005 for CVD related medical costs
  5. 5. Respiratory System
  6. 6. Process of Breathing•Inspiration • Air flows into lungs•Expiration • Air flows out of lungs
  7. 7. Normal Oxygenation Process• Cardiovascular:
  8. 8. Normal Oxygenation Process• Systemic:
  9. 9. Normal Oxygenation Process
  10. 10. Inspiration• Diaphragm and intercostal muscles contract• Thoracic cavity size increases• Volume of lungs increases• Intrapulmonary pressure decreases• Air rushes into the lungs to equalize pressure
  11. 11. Expiration• Diaphragm and intercostal muscles relax• Lung volume decreases• Intrapulmonary pressure rises• Air is expelled
  12. 12. Gas Exchange• Occurs after the alveoli are ventilated• Pressure differences (gradient) on each side of the respiratory membranes affect diffusion • Alveoli: • PO2 100mmHg • PCO2 40mmHg • Venous blood: • PO2 60mmHg • PCO2 45mmHg• O2 diffusion from alveoli pulmonary blood vessels• CO2 diffusion from pulmonary blood vessels  alveoli
  13. 13. Adequate O2 Balance• Maintenance of adequate O2 balance Gas Exchange
  14. 14. Oxygen Transport• Transported from the lungs to the tissues• 97% of O2 combines with RBC Hgb  oxyhemoglobin carried to tissues• Remaining O2 is dissolved and transported in plasma and cells (PO2)
  15. 15. Normal Oxygenation Process• Cell environment / O2 carrying capacity:• O2 Carrying capacity of blood is expressed by: • Red blood cells (#) • Hematocrit • % of blood that is RBCs • Men 40-54% • Women 37-50% • Hemoglobin
  16. 16. Carbon Dioxide Transport• Must be transported from tissues  lungs• Continually produced in the process of cell metabolism• 65% – carried inside RBCs as bicarbonate (HCO3-)• 30% – combines with Hgb  carbhemoglobin• 5% – transported in plasma as carbonic acid (H 2CO3)
  17. 17. Factors that Influence Respiratory Function• Age• Environment• Lifestyle• Health status• Medications• Stress
  18. 18. Common Manifestations of Impaired Respiratory Function•Hypoxia•Altered breathing patterns•Obstructed or partially obstructed airway
  19. 19. Hypoxia• Condition of insufficient oxygen anywhere in the body• Rapid pulse• Rapid, shallow respirations and dyspnea• Increased restlessness or lightheadedness• Flaring of nares• Substernal or intercostal retractions• Cyanosis
  20. 20. Abnormal Respiratory Patterns• Tachypnea (rapid rate)• Bradypnea (abnormally slow rate)• Apnea (cessation of breathing)• Kussmaul’s breathing• Cheyne-Stokes respirations• Biot’s respirations
  21. 21. Alterations in Ease of Breathing• Orthopnea• Dyspnea
  22. 22. Obstructed or Partially Obstructed Airway• Partial obstruction • low-pitched snoring during inhalation• Complete obstruction • extreme inspiratory effort with no chest movement
  23. 23. Adequate O2 Balance Example of Obstructive Disease: Asthma•
  24. 24. Adequate O2 Balance Example of Restrictive Disease: Hemothorax•
  25. 25. Inadequate O2 Balance• Behaviors of Negative O2 balance • Hypoventilation or hyperventilation • Stridor, audible sounds with respiration, wheezing, coughing • Hypoxia • Change in mental status • Change vital signs • Cyanosis • Decrease in GI motility • Change in renal function • Hypercapnia
  26. 26. Nursing Responsibilities• Determine adequacy of cardiopulmonary function: • Nursing assessment • HEART • Respiratory assessment • PMH • LIFESTYLE
  27. 27. HEART• Have client describe • specific location, onset and duration of the problem• Explore associated signs and symptoms• Ask - activities that worsen or ease the problem• Rate the severity of discomfort or incapacity• Talk - treatments or interventions used to alleviate the problem and their effectiveness
  28. 28. Heart ProblemsArtheroscleosis = Coronary Artery Disease (CAD)
  29. 29. Nursing Measures to Promote Respiratory Function• Ensure a patent airway• Positioning• Encourage deep breathing, coughing• Ensure adequate hydration
  30. 30. Nursing Responsibilities• Physical Assessment: • Lung auscultation and breathing pattern • Abdominal assessment • Urine output • Skin and mucous membranes • Heart sounds • Circulation • Edema • DVT
  31. 31. Lung sounds• Diminished or absent• Crackles course and fine • discontinuous course bubbling • fine crackling sound at the middle or end of inspiration• Rhonchi • a continuous sonorous sound• Wheezes • high pitch musical sounds• Pleural friction rub • grating rubbing, sound
  32. 32. Common Tests and Nursing Responsibilities•Measure adequacy of ventilation and gas exchange • Complete Blood Count (CBC)  phlebotomy • Arterial Blood Gases (ABG) arterial puncture • Pulmonary Function Tests preparation by teaching
  33. 33. Common Tests and Nursing Responsibilities•Tests to determine abnormal cell growth or infectionin respiratory system: • Sputum culture • growing microorganisms from sputum • Throat culture • growth of microorganisms from throat material
  34. 34. Common Tests and Nursing Responsibilities• Tests to visualize structures of respiratory system: • Bronchoscopy • Chest radiographs
  35. 35. Chest XrayAdenocarcinoma
  36. 36. Common Tests and Nursing Responsibilities Thorancentesis
  37. 37. Nursing Responsibilities• Medications• Incentive spirometry• Chest PT• Postural drainage• Oxygen therapy• Artificial airways• Airway suctioning• Chest tubes
  38. 38. Basic Nursing Interventions• Airway Maintenance: • Facilitate effective coughing • Suctioning airways • Liquefying and mobilizing sputum
  39. 39. Basic Nursing Interventions• Maintenance and promotion of proper lung expansion:Re-expanding collapsed lungs- Closed Chest Tube Drainage
  40. 40. Chest Tubes
  41. 41. Basic Nursing Interventions• Improving Activity Tolerance: • Determine etiology • Assess appropriateness of activity level • When appropriate gradually increase activity • Ensure the client changes position slowly • Observe for symptoms of intolerance • Syncope with activity • refer to MD • Perform ROM exercises with activity intolerance if is immobile
  42. 42. Basic Nursing Interventions• Mobilization of Pulmonary Secretions • Auscultate breath sounds, monitor respiratory patterns, monitor ABG’s • Position client to optimize respiration • Pulmonary toileting • Incentive spirometry • Suctioning
  43. 43. Incentive spirometry
  44. 44. Basic Nursing Interventions• Mobilization of Pulmonary Secretions • Encourage activity and ambulation as tolerated • Encourage increased fluid intake • Chest physiotherapy • O2 • Medications as ordered
  45. 45. Basic Nursing Interventions• O2 Therapy: • Low flow • High flow • Humidification • Nasal cannula • Simple mask • Nonrebreathing mask • Partial rebreathing
  46. 46. Basic Nursing Interventions • Effective Breathing Techniques• Position for maximal respiratory function• Pursed lip breathing• Diaphragmatic or abdominal breathing
  47. 47. Basic Nursing InterventionsStress and anxiety reduction:• Remove pertinent cause of anxiety at that moment - help client gain control over respiration - reassure client not in immediate danger• Chronic clients • exacerbations and remissions • goal is to reduce general level of anxiety • learn to control episodes of anxiety to improve quality of life • desensitization program • guided mastery
  48. 48. Administration of Prescribed Medications• Expectorants • Vasoconstrictors• Mucolytics• Bronchodilators• Cough suppressants• Corticosteroids• Antihistamines• Antibiotics
  49. 49. Basic Nursing Interventions• Physical Exercise health teaching Activity and rest -- a priority ! Activity stimulates respiratory function Rest conserves energy and reduces metabolic demand • MD’s treatment plan • guidelines for activity • may simply call for activity as tolerate. • prioritize activities • arrange need items conveniently • Provide emotional support and encouragement • gradually increase activity • Simplify daily life • Work at a steady state • Conserve energy
  50. 50. Adequate O2 Balance• Behaviors of Negative O2 balance  Cardio Vascular Disease• Arterial• Venous:• Impaired tissue perfusion
  51. 51. Adequate O2 Balance• Behaviors of Negative O2 balance  CV• Restlessness, dizziness, syncope, bradycardia, decreased urine• cold and clammy skin, cyanosis, slow capillary refill• Decreased cardiac output
  52. 52. Common Tests and Nursing ResponsibilitiesTests to determine adequacy of cardiovascular •function: • CBC • Lipid profile • Coagulation studies • EKG/ECG • Angiography
  53. 53. Basic Nursing InterventionsCardiovascular •Diet• Modify risk factors •Exercise •Co morbidities• Preventing vasoconstriction •Positioning •Cold temperatures •Nicotine
  54. 54. Basic Nursing Interventions• Cardiovascular •Risk DVT •Position changes - Prevent •Early ambulation complications •Obstruction removal •Bypass surgery • Promoting rest •Schedule rest periods •Assistance with ADL’s •Monitor Vitals with activity •Place items, i.e. call light, water pitcher, strategically •Quiet environment, decrease stimuli
  55. 55. Basic Nursing Interventions - Position semi to highCardiovascular fowlers-> decrease venous• Positioning to improve return and preload, decease preload-> decreases risk of CO heart congestion -• Avoiding Valsalva • Teach client to avoid valsalva maneuver maneuver - Hold breath while turning or moving in bed-> assist - Bearing down during BM-> stool softeners and diet
  56. 56. Basic Nursing InterventionsCardiovascular •Avoid appetite suppressants, cold• Avoid stimulants meds, coffee, tea, chocolate• Maintaining fluid balance •Assess fluid status, monitor I&O, assess breath sounds, JVD, pitting edema in dependent areas, fluid and NA+ restriction, daily Wgt with diuretic therapy, electrolyte monitoring-> MD
  57. 57. Basic Nursing Interventions • Administer O2Cardiovascular • Educate client• Increase O2 supply NO SMOKING! • Position to facilitate breathing
  58. 58. Administration of Prescribed Medications• Anti coagulants• Vasodilator Medications• Inotropic Medications• Anti Dysrhythmics• Anti hypertensives
  59. 59. Basic Nursing Interventions• Dietary control • Assess nutritional status • Consider a dietician referral to assess nutritional needs related to clients • Chronicity of CAL and CAD and nutrition
  60. 60. Basic Nursing Interventions• Weight control• Evaluate the client’s physiological status in relation to condition • More than body requirements • Less than body requirements

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